Contributions of Buddhism to Ancient Medical Science in Ancient India and Sri Lanka
113
［特別寄稿］
Contributions of Buddhism to Ancient Medical Science
in Ancient India and Sri Lanka
T. G. Kulatunge
The indigenious medical science present in Sri Lanka in ancient times
was very similar to that of Northern India. Siddhāyurveda, which had been
an offshoot of the Northern Āyurvedic tradition had also influenced the Sri
Lankan medical system. Although archaeological evidence has shown that
there were human settlements here before the arrival of the Āryans, there
is little evidence of a medical system at that time. Some scholars argue for
the existence of an ancient Rāvaṇa age in Sri Lanka, before the arrival of
Āryans, and they also posit the existence of a ṛṣi named Pulasti who was
versed in medical science.(1) However, there is no evidence to support this
theory.
Later sources such as the Rājāvaliya written in the 17th century,(2) the
Kurunǟgala Vistaraya, a minor literary work of 14th century, the Kaḍaim
Pot or the Books of Boundaries in Sri Lanka written during 14th–17th
centuries,(3) and a few Ola leaves in the Colombo Museum(4) mention a Sri
Lankan king called Rāvaṇa, yet no source before this period provides any
reference to him. The aforesaid references are allusions to the Lankāpura
of Rāvaṇa mentioned in the famous Indian classic the Rāmāyaṇa. Senarat
Paranavitana argued that the Laṅkāpura of the Rāmāyaṇa, according to
context, had been a place in South India.(5) H.A.P. Abeywardhana, who
published a dissertation on Kaḍaim Pot (Books on Boundaries) in Sri
Lanka, states that Lankāpura in the Rāmāyaṇa is an imaginary land and
that there are no reasons to take it as Sri Lanka.(6) A. B. Keith, who also
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examined this problem, says that the Lankāpura of the Rāmāyaṇa is a
place near Mahendragiri Mountain in South India and not a place in Sri
Lanka.(7) G. P. Malalasekara says that there is no satisfactory evidence to
support the views that a ṛṣi named Pulasti from Sri Lanka participated in a
medical conference held in India and that Pulasti’s grandson Rāvaṇa studied
medical science from Pulasti and wrote two books on medicine namely, the
Arka Prakāśa, Nāḍi Parīkṣāva and the Kumāra Tantra.(8) There is again a
legend that Rūmassala mountain, which abounds in medicinal herbs, had
been a part of the portion of Himalaya mountain that fell while Hanuman
was flying with it. This myth might have originated through the belief in
the Rāvaṇa stories noted above. When all of this evidence is taken together,
stories about the existence of a pre-Aryan medical service in Sri Lanka
cannot be maintained.
Whatever the case may be, we need to understand first what medical
practices existed in Sri Lanka. Secondly, we need to know which individuals
were instrumental in the development of medical science in India and in
Sri Lanka. The oldest books on medicine found in Sri Lanka were written
during the 13th century by the Chief Incumbent Thera of Mayūrapāda
Pirivena. These books are the Yōgārṇavaya and the Prayōgaratnāvaliya.
During the same period, the Chief Incumbent Thera of Pasmula Pirivena
wrote the Bhēsajja Mañjūsā in the Pāli language. It is believed that the
Sārārtha Saṅgrahaya, which is a medical treatise, was written by King
Buddhadāsa (340–368 CE).(9) C.E. Goḍakumbura says that the book was
first written by King Buddhadāsa and it was later translated into Sanskrit.(10)
Paranavitana opines that although it is generally accepted that the Sārārtha
Saṅgrahaya was composed by King Buddhadāsa, its language and context
points to a later age of composition.(11) The 1903 edition of Sārārtha
Saṅgrahaya mentions that it belonged to King Buddhadāsa, and this view
was endosed by Hikkadiwe Sri Sumangala Thera as well. Punchibandara
Sannasgala says that as he had heard, the original book was taken to India
by a Brahmin named Vaṅgasēna who published it.(12) Malalasekara accepts
Contributions of Buddhism to Ancient Medical Science in Ancient India and Sri Lanka
115
it as a work by King Buddhadāsa and that its commentators had included in
it South Indian system of Agnikarma and Mahāyānic type of treatments.(13)
Wimala Wijesooriya, who was a specialist in oriental studies, opposes
the view of Paranavitana and says that there is no reason to say that the
Sanskrit language of the book is different from that at the time of King
Buddhadāsa.(14) Paranavitana answers the criticism saying that the word trī
siṃhala found in this book did not exist during the Anuradhapura period,
and that it belongs to a later period. Secondly, the statement in the book that
King Devānampiya Tissa belonged to the line of kings from King Vijaya(15)
was not an idea that existed during the Anuradhapura period. Kings of the
Anuradhapura period claimed descent from the Okāvas line.(16) The concept
of the connection to the Vijayan line of kings first appeared in the 12th
century in the inscriptions of King Nissaṅka Malla.(17) The book begins with
a salutation to the Buddha, which shows that King Buddhadāsa, the author
of the book, was Buddhist.
Although there are several inscriptions that refer to the medical
system of the Rajaraṭa period, there are no literary works written on the
subject at that time. Above-mentioned works like the Prayōgaratnāvaliya,
Yōgārṇavaya, and Bhēsajja Mañjūsā were composed by Buddhist
monks. Even a commentary to the Sārārtha Saṅgrahaya was done by
Väliviṭa Saranaṅkara Thera in the 18th century. Several medical treatises
are mentioned in it, and they were written by Buddhists. The Bhēsajja
Mañjūsā mentions 74 books that were its sources, but only three of them
are available today. Had these books been found today, the story of medical
science in Sri Lanka would have been different. One of those books is called
Mahāyānaya. This indicates the Mahāyānic influence on medical science.(18)
A medical treatise called Yogaratnākaraya had 4457 verses, and it was
also composed by a Bhikkhu named Monaragammana during the Gampola
period.
Early works on medicine found in Sri Lanka share a common basis
of medical science followed in India. An example is the basic assumption
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that the cause of disease is the loss of equilibrium in “vā” (air or wind),
“pit” (bile), and “sem” (phlegm) of the body.(19) Further, all of the aforesaid
medical works commenced with a salutation to teachers like Suśruta,
Caraka, and Vāgbhaṭa. For instance, the introduction to Yōgārṇavaya
has the saying, “The medical science declared by the ṛṣis Caraka,
Suśruta, and Vāgbhaṭa for the welfare of the world… etc.”(20) Similarly,
Prayōgaratnāvaliya also begins with the statement, “This science was
first declared by the sacred mouth of Hiraṇyagarbha to able Prajāpati.
Prajāpati told it to Aśvinī, Aśvinī told it to Vajrapāṇī and Vajrapāṇī told it to
Dhanvantarī. Dhanvantarī told it to Suśruta.”(21) There is no doubt that the
medical science that was practised in Sri Lanka was closely related to that
found in India.
Brahmins in India had from the ancient period condemned and
ridiculed physicians and their medical science so that no amount of
encouragement was given to medical service in their literature. Subhāṣita
Ratna Bhāṇḍāgāra condemns the doctor thus:
vaidyarājanamastubhyaṁ yamarājasahōdara,
yamastuharatiprāṇanaṁ vaidyaprāṇātdhanānica.
Salutations to the physician, the brother of Yama.
Yama carries away life. The physician carries away both life and
wealth.(22)
Such condemnation was not found in Ṛg veda. But it appears from the time
of the Yajur Veda. The Yajur Veda says, “The two physicians who associate
the people as Aśvinins are impure. The Brahmins should not study medical
science. Why? The doctor is impure; not fit for Yāga and Homa.”(23)
Brahmins treated the doctor as impure because many doctors treated all
people alike irrespective of the patient’s caste. Among Hindus, people are
either pure or impure, high or low, the higher castes are pure while the lower
castes are impure. Impure ones are untouchables, but doctors used to touch
them during medical practice. It is taboo to touch or associate with lowcaste people. The Brahmins who aspire to reach mokṣa should not study
Contributions of Buddhism to Ancient Medical Science in Ancient India and Sri Lanka
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medical science, as told in their sacred literature. The Atharva Veda, which
had a chapter on treatments of the sick, was excluded from Vedic literature
during the Samhita period. For example, the Taittireya Saṃhitā refers
only to three out of four Vedas—they being the Ṛg, Yajur, Atharva and
Sāma. Even in Upaniṣadic literature, the physician who is so important to
society is mentioned only once, and that is in the Chāndogya Upaniṣad.(24)
Up to the time of the Manusmṛti, Brahmins continued to treat doctors as
abominable and impure. For instance, the Manusmṛti says, “The food given
by a doctor is as impure as pus. Food given by a doctor is the same as pus
or impure blood.”(25) Taxila, which was a place where medical science was
taught in ancient India, was considered an impure place that the Brahmins
should abhor.(26) This was the message that the Brahmins gave; the people
of upper castes should not study medical science. In the Brahmanic fold,
only the people of the Ambaṣṭha caste were permitted to study medicine.
The Manusmṛti says that the Ambaṣṭha caste was a low caste that originated
when Brahmin men associated the women of the Vaiśya caste. The
Manusmṛti also declares physicians to be the same as vendors of flesh and
irrational merchants. One should neither give nor accept alms from them.(27)
Jīvaka Kumārabhṛta, who studied medicine at Taxila for a period of seven
years, was neither a Brahmin nor a Kṣatriya. He was born of a prostitute.(28)
Although it seems that Brahmins generally detested doctors and
medical science, the Buddha and the Buddhists in ancient India followed
a different policy. The reason that the Brahmins and the Buddha followed
contradictory policies was that the Brahmins upheld the caste system
whereas the Buddha rejected it. Since the Buddhists rejected the efficacy of
the caste system, they had no grounds for considering people of low caste
as impure. Therefore, Buddhists had no reason to reject medical science
nor any reason to abhor the physician. As stated in Buddhist literature, the
great physician named Jīvaka Kumārabhṛta(29) had been a devout Buddhist.
The Buddha is considered to be a physician sometimes, but he was a
physician for the treatment of diseases in saṃsāra, not a doctor treating
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physical ailments. The Bhēsajja Mañjūsā, written in the 13th century by the
chief incumbent Thera of Pasmula Pirivena, states, “abhivādiya satthāraṁ
manōrōga cikitsakaṁ-sabbrahmacārinō bhikkhu jātaveyyantiyāpamu” (The
physician for the diseases of desire such as lōbha (lust), dvēśa (hatred or
anger), and mōha (deceit) in the minds of the people). It has to be noted
that whereas the Brahmins ridiculed the physician as impure as a vendor
of flesh, the Buddhists eulogise the Buddha as a great physician to cure the
spiritual diseases of saṃsāra.
There are instances recorded in Buddhist literature when the Buddha
himself attended to sick bhikkhus and instances when he prescribed
medicines to cure diseases. There is the Buddha’s saying, “yō gilānaṁ
upaṭṭhānaṁ sō upaṭṭhānaṁ maṁ iti.” (He who ministers to the sick
ministers to me). The Buddha treated Bhikkhu Bēlaṭṭasīsa afflicted with
a scratching disease, prescribed the application of sandal in the eye for
a bhikkhu who had an eye disease, and there are other instances of the
Buddha’s medical practices.(30)
Yet another instance is prescribing a medicine called lōṇasōvīraka to
a patient suffering from a stomach disease.(31) Lōṇasōvīraka is a medicine
made of araḷu (Terminalia parviflora), bulu (Terminalia belerica), nelli
(Phyllanthus emblica), grains like mung (Phaeoius anreus) and rice, fruits
such as bananas, sprouts and fronds such as väṭakē (Pandanus rectorias),
pieces of meat and fish, different kinds of grapes and bees honey, Sindhu
salts, and various spices. This is placed in a pot and sealed with mud paste
and kept to ferment for a year or two or three, and then filtered for use.(32)
Thus, lōṇasovīraka was not an instantly prepared medicine; it was an ariṣṭa
ready-made, for use whenever necessary. In the Bhēsajja Khandhaka of
the Mahāvaggapāḷiyā, it is said that whenever a bhikkhu gets sick, such
and such a treatment ought to be prescribed. The Bhēsajja Mañjūsā states,
“kallahōtu rōgōsu annamanna cikitsakō.”(33) That means that whenever
the bhikkhus get sick, they should minister to each other. This was a policy
followed in the order of bhikkhus—the Sāsana. It appears from the above
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119
that the Buddha as well as other educated persons were acquainted with a
sound knowledge of medical practice.
There were in North India three great teachers of medicine, namely,
Suśruta, Caraka and Vāgbhaṭa, who wrote, respectively, the Suśruta
Saṃhitā, which deals with surgery, the Caraka Saṃhitā, which deals with
general physical ailments, and the Aṣṭāṅga Hṛdaya Saṃhitā, which is a
mixture of the above two aspects of medicine. These teachers established
different schools of medicine that influenced medical practice across Asia.
Vṛddhatara in Āyurveda means the above three schools of study. Caraka
was the royal physician of the Buddhist Emperor Kaniṣka, who ruled
western and northwestern India during the first century CE.(34) Bhagawat
Ram Gupta, who completed a special study on North Indian medical
systems, says that the name Caraka appears in the Yājñavalkya, which is a
work of 3rd century CE. Therefore, it is presumed that the Caraka Saṃhitā
was written before the 3rd century. Certain sections of the Caraka Saṃhitā
were completed in the 4th century by a teacher named Druḍabala who was
born in Kashmir.(35) The name Caraka means “walker,” and it is said that
he walked about to find patients suffering from diseases. Therefore, the
name would have been a pseudonym. Caraka was a bhikkhu of Mahāyāna
denomination.(36) Kaniṣka was also a Mahāyāna Buddhist, and it was he
who for the first time in history published a coin with the figure of the
Buddha. It is the Kashmirian chronicle Rājataraṅgaṇī that directly says that
Caraka was a Buddhist. (Ibid.)
Vāgbhaṭa, who wrote the Aṣṭāṅga Hṛdaya Saṃhitā, was a resident of
Sindhu Desa and studied medicine from his family members.(37) His book
states that he was a Buddhist. In its Sūtra Adhyāya 18, the following is
found:
namo bhagavate bhaiṣajyaguruve vaidyāyadaruya
prabrārajaya tatāgathāyarata samyaksambuddhāya.(38)
The term Bhaiṣajyaguru here refers to a Mahāyāna Buddha. Further,
the section on Uttara Pañcama Adhyāya has a section on ghosts. It has
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mantras to heal the sick, among which are euologies to Avalokiteśvara
and Mahāmāyurī, which clearly illustrate Mahāyāna influence. Gupta has
shown how Avalokiteśvara Bodhisattva and Mahāmāyūrī were treated
with reverence.(39) As told in the Yōgārṇavaya, Jīvaka and Suśruta were
physicians who lived in Taxila, which was a place abhorred by Brahmins.
The author of the Pūjāvaliya was the chief incumbent of Mayūrapāda
Pirivena. In the Pūjāvaliya, the author aspires to be a Buddha, which
indicates his Mahāyāna affiliations. The author of the Bhēsajja Mañjūsā
was the chief incumbent of Pasmula Pirivena, and he too shows
Mahāyānic affiliations. Asaṅga, who was a Mahāyāna teacher, wrote in the
Mahāyānasūtrālaṅkāra that a bhikkhu should study medicine not for his
personal gain but for the good of others.(40) Pasmula Pirivena, who wrote
the Bhēsajja Mañjūsā, says at its beginning that a healthy mind lives only
in a healthy body, and thus one can attain his goal only through achieving a
healthy mind.
The Saddharmapuṇḍarīka states that until the appearance of
Maitreya Buddha, the people and the world are protected by Bodhisattva
Avalokiteśvara. Especially during the second part of the Anurādhapura
period, Mahāyānism spread in Sri Lanka, having Abhayagiri as its centre.
Avalokiteśvara images are seen holding a pot of ambrosia in the left hand,
which depicts immortality.(41) Such images were discovered due to being
enshrined in the Abhayagiri Stūpa. There is a belief that Bodhisattva
Avalokiteśvara had the power to heal. This power of healing is depicted in
the Avalokiteśvara image at Väligama Kuṣṭarājagala and in the image at
Daæbēgoḍa, as pointed out by Nandana Chutiwongs.(42) The Mahāvaṃsa
refers to a hospital built for the blind and for other patients by Agbo IV
(667–683 CE) at a place called Kanagama. Kanagama has been identified
as Daæbēgoḍa, where the Avalokiteśvara image stands.(43) Nepalese
inscriptions from the 11th century mention that the Muni of Sri Lankan
hospitals was Avalokiteśvara.(44)
Accordingly, with the spread of Mahāyānism in Sri Lanka, the
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121
bhikkhus began to study medical science and to practise it. As an instance
it has already been shown that the incumbent Thera of Mayūrapāda
Pirivena, who wrote the Yōgārṇavaya and Prayōgaratnāvaliya had been a
Mahāyānist. It is important to note that the two pirivenas Mayūrapāda and
Pasmula had been two out of the Eight Institutions (Aṣṭāyatana). Bhikkhus
who studied in these pirivenas studied medical sciences, and the chiefs
of the two pirivenas wrote books for the propagation of medical science.
During the Sri Jayavardhanapura Koṭṭē period, the syllabus of Vijayabā
Pirivena in Toṭagamuva included the teaching of medical science. This is
referred to thus: “Vedavaru veda satara uganiti ehi satosa” (‘the medical
practitioners (in that temple) are studying the traditional art of medicine as
prescribed by the ancient sages’).(45)
The Aṅguttara Nikāya has stated that ministering to the sick was a
requisite of a bhikkhu.(46) However, certain works of Buddhist literature
and the Katikavatas speak against bhikkhus practising medical service.
The Daæbadeṇi Katikāvata, for instance, calls it a beastly science. These
statements should not be interpreted to show that bhikkhus, like certain
Brahmins, abhorred medical science along with physicians. It only means
that the ones who entered the Sāsana after renouncing worldly life should
not continue to perform former worldly duties done by the laity. It is
harmful to ordained life. Because of this situation, bhikkhus were barred
from practising medical service in the Brahmajāla Sutta of the Dīghā
Nikāya and also in the Samaññaphala Sutta.(47) Theravāda Buddhism
permitted bhikkhus to practise medicine at the early stages, on a limited
scale. Thus, “When the mother of the teacher, being ill, comes to the
Vihāra when the teacher is not present, a colleague should issue medicine
that belongs to the teacher. Or else, one should give his own medicine as
a donation to the teacher. This ought to be done even to the other teachers.
The Samantapāsādikā says that “one should do similarly even to a stranger,
a thief, to a rich person who is defeated in battle, a destitute person who
is abandoned by relatives, or a traveller, without consideration for any
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personal gain.”(48) The Aṭṭhakathās also show that bhikkhus knew about
medical practice. A reference in the Visuddhimagga may be cited as an
example. When the mother of Thera Mahamitta was afflicted with a disease
having a poisonous boil, she called to her daughter and asked her to go to
her brother Thera Mahāmitta to ask for medicine.(49) Samantapāsādikā has
evidence to show that bhikkhus knew about medical practice, as shown
here. “Sir, my mother is sick. Please give me medicine.” Once this is told,
they should inquire, “Sir, when such and such a bhikkhu was afflicted with
this kind of disease, what was the medicine issued?” They ought to discuss
among themselves what the medicine issued had been.”(50) In this way, the
permission was given to the bhikkhus to treat outsiders, starting from one’s
own parents, then brothers and sisters, and their wives, etc.(51) Daæbadeṇi
Katikāvata was written in accordance with the theory of the Vinaya, yet it
must be considered that in practice, at the same time, the chief bhikkhus
of the Pirivenas taught medical science, specialised in that field, and wrote
books on medical subjects.
The Caraka Saṃhitā shows the entry into the system of diagnosing
a disease critically with attention to actual facts, rather than believing
that diseases are caused by mysterious powers such as that of gods or
ghosts, and thereby resorting to prayers or chanting mantras or stotras to
overcome them. The critical method of the Caraka Saṃhitā was called
yuktivyāpārasaya through the Bhesajja method.(52) The Caraka Saṃhitā
shows that the doctors should pay attention to actual reality in diagnosing
a disease relying on the Buddhist theory of cause and effect, or causation
as it is generally called. Further, it says that a disease is a disease and not
a mysterious thing, and that the doctor should have confidence to heal the
sick patients.(53) The basic concept of causation in diagnosing diseases
found in Āyurveda is the same as causation in Buddhist philosophy. Since
Caraka was a Buddhist, he applied Buddhist concepts for the development
of medical science.
An examination of the above sources would reveal that the medical
Contributions of Buddhism to Ancient Medical Science in Ancient India and Sri Lanka
123
system that existed in North India was closely related to that found in Sri
Lanka. Although there are stories that the medical system in Sri Lanka came
down from the time of the so-called “Rāvaṇa period”, there is hardly any
substantial reason to support such a theory. It has been argued here that the
concept of Varṇa Dharma- i.e. caste structure within the Brahmanic foldled to condemnation of medical science, physicians, and even the places
where medical science was taught. The Buddha and Buddhists adopted a
contrary view of the subject. All three schools of medicine found in North
India belonged to Buddhist teachers of medicine. The impact of Mahāyāna
Buddhism on the development of medical schools is also evident. Sri
Lanka too followed the teaching of medical science through Pirivenas, and
bhikkhus themselves specialised in medical subjects. Consequently, it has
to been argued that the development of Indian and Sri Lankan Āyurvedic
medical systems was largely the work of Buddhists.
Notes
(1)
Ñāṇavimala 1944, p. 1; Alavu-isi Säbihela 1985, pp. 265–267.
(2)
Rājāvaliya 1997, p. 172.
(3)
Abeyawardhana 1978, p. 189.
(4)
Nos. 22 J 15; 7 M10; 55 B 9.
(5)
Paranavitana 1985, pp. 207–212.
(6)
Abeyawardhana 1978, p. 133.
(7)
Keith 1915, p. 324.
(8)
Malalasekara 1985, pp. 70–71.
(9)
Ñānavimala 1944, p. 1.
(10) Goḍakumbura 1966, p. 332.
(11) Paranavitana 1985, p. 208.
(12) Sannasgala 1964, pp. 162–163.
(13) Malalasekara 1994, p. 78.
(14) Wijesooriya 1992, p. 52.
(15) Sārārtha Saṅgrahaya, vv. 1180–1182.
(16) Epigraphia Zeylanica, vol. I, p. 119.
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(17) ibid., p. 63.
(18) Bhēsajja Mañjūsā, p. 340.
(19) Caraka Saṃhitā, Nidhāna, 1:30.
(20) Yōgārṇavaya, p. 1.
(21) Prayōga Ratnāvaliya, p. 2.
(22) Sharma (ed.) 2009, p. 44.
(23) Yajur Veda, pp. X. ii, X.i.
(24) IV, 17. 8.
(25) Manusmṛti, 4, 220.
(26) Thapar 1986, p. 59.
(27) Manusmṛti 3, 152, 182.
(28) Malalasekara (1937–38) 2003, Vol. I, p. 957.
(29) Pāli: Jīvaka Kōmārabhacca.
(30) Mahāvaggapāḷiyā, Dutiyobhāgo, pp. 526–529.
(31) Ibid., pp. 542–543.
(32) Samantapāsādikā, p. 342.
(33) Bhēsajja Mañjūsā, p. 1.
(34) Caraka Saṃhitā, p. 48.
(35) Gupta 2003, pp. 275–277.
(36) Caraka Saṃhitā, 1991, Introduction XVI.
(37) Aṣṭāṅga Hṛdaya Saṃhitā - Uttara Tantra, 50.
(38) Gupta 2003, p. 285.
(39) Ibid.
(40) Mahāyānasūtrālaṅkāra, p. 70.
(41) Kulatunge 2014, pp. 287–315.
(42) Chutiwongs 1990, pp. 133–141.
(43) Ibid.
(44) Ibid.
(45) Girā Sandēśaya, v.225.
(46) Aṅguttara Nikāya, Dutiyo Bhāgo, p. 464.
(47) Rahula 1968, pp. 162–163.
(48) Samantapāsādikā Vol. I, pp. 430–431.
(49) Visuddhimagga, p. 62.
(50) Samantapāsādikā, Vol. I, pp. 430–431.
(51) Ibid., p. 430.
(52) Caraka Saṃhitā, 2, 28.
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(53) Caraka Saṃhitā, 8, 37.
Bibiliography
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